EMLRA Postal Payment Application Form
  1. Main Applicant
  2. First Name:(*)
    Please type your first name.
  3. Last Name:(*)
    Please type your last name.
  4. Associate Applicant (must be resident at same address)
  5. First Name:
    Please type your first name.
  6. Last Name:
    Please type your last name.
  7. Address Details
  8. Address Line 1: (*)
    Invalid Input
  9. Address Line 2: 
    Invalid Input
  10. Town:(*)
    Invalid Input
  11. County/State:
    Invalid Input
  12. Post Code/ZIP:(*)
    Invalid Input
  13. Country:(*)
    Invalid Input
  14. Telephone:
    Invalid Input
  15. Mobile Number:
    Invalid Input
  16. E-mail(*)
    Invalid email address.
  17. You can choose to receive the Newsletter electronically (via an emailed link) or as a hard-copy
  18. Newsletter type
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  19. Vehicle Details
    (we would appreciate you taking a little time to fill this in as
    accurately as you can. If you have no details then enter "no details")
  20. Vehicle type:
    (eg 4x4, FFR, RHD. Please state clearly whether a L/weight, 90, 110 etc).
    Invalid Input
  21. Only membership number (if known), name, first line of address and email address required. Please provide other details if they have changed
  22. AVC Code:
    (eg 1720 0778)
    Invalid Input
  23. MOD Registration:
    (eg 16 GX 60)
    Invalid Input
  24. Contract Number:
    (eg LV2A/004)
    Invalid Input
  25. Date of Manufacture/Date
    into Service:
    Invalid Input
  26. Date Released from service:
    Invalid Input
  27. Chassis Number:
    Invalid Input
  28. Engine Type:
    Invalid Input
  29. Known History or
    information of interest:
    Invalid Input


  30. Publication consent
    We may publish your town, county and country of residence in the club newsletter along with information about the type of vehicle/s you own. Do you consent to this?
  31. Publication consent
    Invalid Input
  32. Invalid Input


  33. Confirm your human by answering the question below. Enter answer in lowercase.
  34. In EMLRA what does the M stand for?(*)
    Invalid Input
  35.